RESUMO
The present study was designed to determine the relationship between neurological testing, anatomical imaging, and electrophysiological monitoring for assessing outcome of cervical spinal cord decompression. We prospectively studied 28 consecutive patients (age 39-76 yr) who were subjected to presurgical-(1-3 wk) and postsurgical (3-4 mo) neurological examination and recording of the median nerve somatosensory evoked potential (SEP). In 13 patients, magnetic resonance imaging (MRI) was also performed. Changes in neurological function, SEP and MRI were evaluated and graded as (1) improvement,(2) no change or (3) deterioration. Neurological outcome (NO) was based on changes in motor grade strength, sensory, reflexes and gait. The SEP outcome was based on changes in latency and disappearance of SEP waveform components whereas MRI evaluation was based on changes in spinal cord and canal diameters. Significance of association between NO, SEP and MRI was determined by Pearson's Chi-Square statistic (P<.05). The SEP improved in 71% (20/28) and deteriorated in 28% (8/28) of the subjects. An association between SEP changes and NO was found in 82% (23/28) of the subjects (P = .0038). Decompression increased the spinal canal diameter in 92% (12/13), and the spinal cord diameter in 38% (5/13) of the subjects. An association between NO, or SEP and MRI was not detected. Changes in median nerve SEP latency appear to be predictive of the neurological status of patients subjected to cervical spinal cord decompression. Postoperative increments in SEP latency or disappearance of the SEP waves were indicative of poor outcome after surgical decompression of the cervical spinal cord.
Assuntos
Descompressão Cirúrgica , Potenciais Somatossensoriais Evocados/fisiologia , Compressão da Medula Espinal/cirurgia , Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Vértebras Cervicais , Distribuição de Qui-Quadrado , Progressão da Doença , Eletrofisiologia , Feminino , Marcha/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Reflexo/fisiologia , Medula Espinal/patologia , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/fisiopatologia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/patologia , Doenças da Coluna Vertebral/fisiopatologia , Resultado do TratamentoRESUMO
We describe a case of Rocky Mountain spotted fever encephalitis and present the associated findings of an MR examination of the brain, which showed increased signal intensity in the distribution of perivascular spaces. Resolution of the MR abnormalities coincided with clinical improvement.